Birth control pills are a medication taken every day to prevent pregnancy. They are sometimes called “the pill” or oral contraception. Most users of the pill take “combination pills.” These contain two hormones - estrogen and progestin.

Some birth control pills contain only one hormone - progestin. These are sometimes called “mini-pills”. Progestin-only pills are good for users who cannot (or prefer not to) take estrogen. The information below includes information about the combined pill only and will be referred to as “the pill” throughout.

The pill is a very reliable birth control method. If the pill is used correctly - that is, taken at the same time each day - fewer than 1 in 100 users of the pill will become pregnant (0.3%). If the pill is not always used correctly, 9 of 100 users will become pregnant (9%). To use the pill correctly, you must take a pill at the same time each day.

There are many combined hormone pills available today, and while each one provides the same effectiveness against pregnancy when used correctly, there are variations between brands in the appearance, composition, and directions for the use of each particular pill. Be sure to ask your healthcare provider or pharmacist for instructions regarding how to take your birth control pill.

BIRTH CONTROL PILLS DO NOT PREVENT SEXUALLY TRANSMITTED INFECTIONS. USE A CONDOM WITH EVERY ACT OF INTERCOURSE TO REDUCE YOUR RISK OF ACQUIRING SEXUALLY TRANSMITTED INFECTIONS.

BEFORE STARTING THE PILL

Be sure that you have informed your health care provider if you:

Take any medications, herbal products, or dietary supplements

Smoke

Have any history of:

Migraine headaches

Hepatitis

Breast lumps or nodules

Diseases involving blood clots

Tumors of the ovaries

Diabetes

High blood pressure

Heart attacks

Cancer of the female organs

Active gallbladder disease

Inflammatory bowel disease

Lupus

Rheumatoid arthritis

Blood clots in your family or blood clotting factor mutations

Bariatric surgery

A solid organ transplant

People with certain health conditions should not use combination pills. Others will need closer monitoring while on the pill to reduce the risk of negative health effects. Your healthcare provider will help you weigh your particular risks relative to taking the pill.

Smoking while on the combination pill significantly increases the risk of certain side effects (blood clots, stroke, heart attack), especially if you are over 35 years old. Ask your health care provider for help with quitting smoking to decrease your risk.

HOW DOES THE PILL WORK?

The pill prevents pregnancy mainly by suppressing ovulation (the release of the egg from the ovary) and by thickening cervical mucus, therefore hampering the transport of sperm and preventing fertilization.

WHAT ARE SOME BENEFITS OF THE PILL?

The pill is safe, convenient, and very effective.

The pill allows for spontaneity.

Most users can get pregnant quickly when they stop using the pill.

Periods may become lighter, less painful and more predictable if you take the pill.

The hormones in pills offer health benefits. The pill can offer some protection against non-cancerous breast growths, iron deficiency anemia, ovarian cysts, pelvic inflammatory disease, PMS symptoms, and menstrual-related migraine headache. Acne is often improved, and the pill offers protection from some cancers such as ovarian and endometrial (the endometrium is the lining of the uterus) cancers.

WHAT ARE SOME DISADVANTAGES OF THE PILL?

Birth control pills do not protect against sexually transmitted infections (STIs). Condoms do help protect against STIs. Use a condom with every act of sexual intercourse to reduce your risk of acquiring STIs.

Birth control pills must be taken every day at the same time for maximum effectiveness.

A prescription is needed to obtain birth control pills. This requires an annual visit to a health care provider.

Some side effects may occur while using birth control pills.

The most common side effects include bleeding between periods, breast tenderness, and nausea. These side effects typically only last for the first few months.

Less likely side effects include a loss of libido (sex drive), vaginal dryness, acne, freckling or darkening of the skin on your face, or depression.

If you are experiencing problems, contact a health care provider BEFORE you stop taking the pill.

Serious side effects are rarely seen because of the lower doses of hormones used in pills today compared to many years ago. Serious side effects that are possible but not likely include:

Migraine headache

Elevated blood pressure

Blood clots (in the rare case these occur, they tend to happen in the leg, arm, or lung. Risk is highest during the first 6 months after starting the pill for the first time or after taking a 2 month or longer break from taking the pill)

Nonmalignant liver tumors

Gall bladder disease

Heart attack

Stroke

Warning signs of serious side effects from birth control pills are listed below. Immediately contact a health care provider if you experience any of the early warning signs. An easy way to remember these early warning signs of a more serious medical condition is to note that the first letter of each symptom spells out ACHES.

Abdominal pain (severe), yellow skin or eyes

Chest pain (severe)

Headaches (severe)

Eye problems (vision loss, vision disturbances)

Severe leg or arm pain or swelling (in the calf or thigh or upper arm)

WHAT ARE THE DIFFERENCES BETWEEN THE DIFFERENT COLOR PILLS IN EACH PACK?

In most pill packs, the first 21 days of pills contain the active hormones. These pills are often called the “active pills”. They may be all one color or three colors if you are using a triphasic pill. Each color indicates a different amount of estrogen, progestin or both, depending on which brand of pills you take. The last 7 days of 28-day packs contain inactive “reminder” pills. You are protected from pregnancy while using the inactive pills. If the last week’s pills are brown, they may be iron tablets. The purpose of the inactive pills is to continue the habit of taking a pill each day. Some people choose not to take the inactive pills. Do not stop taking the pill during the hormone (or “active”) pill weeks unless directed by your health care provider.

You should expect your menstrual bleeding to occur during the week when you are on the inactive pills. It can start on any one of those days, and it may or may not end before you start your new pack. Start your new pack immediately after finishing your last packet of pills, even if you are still bleeding.

HOW DO I START TAKING THE PILLS?

There are three ways you can start taking the pills.

Start method

Instructions

Backup Method Instructions

Quick Start (recommended)

Start your first packet of pills any day of your menstrual cycle if you are reasonably sure you are not currently pregnant.

Use a backup method such as condoms for the first 7 days of the pack.

Sunday Start

Start your first packet of pills on the first Sunday after your menstrual flow begins.

Use a backup method such as condoms for the first 7 days of the pack.

Day 1 start

Start your first packet of pills on the first day of your menstrual flow.

You are protected against pregnancy as soon as you start taking the pill.

Regardless of which method you use, take one pill each day until you finish the packet. Upon completion of the packet, begin the next packet of pills immediately the next day. Remember, the pill, when used correctly, only protects against pregnancy. It does not protect against sexually transmitted infections. Use a condom with every act of sexual intercourse to reduce your risk of acquiring a sexually transmitted infection.

HOW SOON WILL I BE PROTECTED AGAINST PREGNANCY?

As shown in the chart above, when you begin your first pack of pills, you should use a backup method of birth control, such as condoms, for the first 7 days of the pack if you use the Quick Start or Sunday Start method. If you begin taking your pills on the first day of your menstrual flow, you do not need to use a backup method for the first 7 days.

WHEN SHOULD I TAKE MY PILL?

Take your pill at approximately the same time each day. The effectiveness of the pill depends upon your consistency. Approximately 9 out of 100 birth control pill users become pregnant each year when they do not take their pill at approximately the same time each day. They are also more likely to experience side effects such as irregular bleeding. You might find it helpful to take the pill with another activity that you do at the same time each day, such as brushing your teeth or eating a meal, setting an alarm on your phone, or using a birth control reminder app (it's free!).

IF I DON’T WANT TO HAVE MY WITHDRAWAL BLEEDING (“PERIOD”) AT A PARTICULAR TIME, CAN I JUST SKIP THE INACTIVE PILLS?

One advantage of the pill is the ability to both predict and manipulate your cycle. Consult with your health care provider before taking the pill other than as directed. If you simply take two packs of hormone or active pills consecutively (and skip the inactive pills), you may experience irregular bleeding. For information about how to avoid your withdrawal bleeding on a particular date, consult your health care provider with as much advance timing as possible or look at Bedsider's info on skipping a period using the pill or Reproductive Access' info on skipping a period.

The active pills may be used safely for extended periods of time (24, 42, 63, or 84 days of active pills or continuous active pills). Consult your health care provider if you have questions about extended regimens. See Bedsider's information on extended use of the birth control pill.

WHAT IF I MISS A PILL?

If you are less than 12 hours late taking your pill, take it now and take your next pill at the time you usually would. No further action is needed.

If you are more than 12 hours late, take your missed pill now and any other pill you are supposed to take today. Take emergency contraception if you have had penile-vaginal sex in the last 5 days without additional protection such as a condom. Use a backup method such as abstinence or a condom with every act of sex until you have taken 7 active pills in a row. Finish taking all other pills in your pack on time.

If you have lost a pill, follow the appropriate instructions above, then take the next pill in the pack and continue to take the remaining pills every day. You will begin your new packet of pills one day sooner.

WHAT IF I MISS AN INACTIVE PILL?

If you are using a 28-day pack of pills and you forget any of the 7 inactive pills (which have no hormones) in week 4, discard the pills you missed and keep taking one pill each day until the pack is empty. You do not need a backup method of birth control.

WHEN ARE TIMES I SHOULD USE A BACKUP METHOD OF BIRTH CONTROL TO PREVENT PREGNANCY?

The first 7 days of your first packet if you use the Sunday or Quick Start methods

If you miss active pills. Get more info about this situation by reading “WHAT IF I MISS A PILL?” above.

If you vomit within 1-2 hours after taking an active pill, consider it a missed pill and refer to the previously provided instructions

If you have severe diarrhea (>3 loose stools in 24 hours), consider it a missed pill and refer to the previously provided instructions

If you take other medications that may decrease the effectiveness of the pill (see “ARE THERE ANY DRUG INTERACTIONS WITH THE PILL?” below)

WHAT IS EMERGENCY CONTRACEPTION AND WHEN MIGHT I NEED IT?

Emergency contraception (Plan B® or Ella®, also called “the morning-after pill”) is given as soon as possible within 120 hours of intercourse without effective contraception. Emergency contraception is meant for emergency use only and is not an effective method of birth control for routine use. Sometimes when you are on the pill, you need to also use a backup method of birth control (see “WHEN ARE TIMES I SHOULD USE A BACKUP METHOD OF BIRTH CONTROL TO PREVENT PREGNANCY?” above). If you are in a situation where you need a backup method, have had intercourse and either your backup method failed or you didn’t use a backup method, you should consider emergency contraception. Some types of emergency contraception are available over-the-counter. Other types don’t require a prescription but may be kept behind the pharmacy counter. For more information, you may call (919) 966-2281 or see the additional resources on the right.

WHAT DO I DO IF I MISS A PERIOD?

If you took all of your active pills and skip a period, it is unlikely that you are pregnant. It is common for pill users to occasionally miss periods and for their periods to be very light and last only one day or less. If you skip a period and are concerned about your risk of pregnancy, contact a health care provider and ask for a pregnancy test. Even if you did not have a period, you should start a new package of pills at the regularly scheduled time. If you skip two periods in a row, contact your health care provider.

WHEN SHOULD I BE SEEN AGAIN BY MY HEALTH CARE PROVIDER?

See your health care provider once a year for a wellness visit. A wellness visit is necessary to renew your prescription for birth control pills. Testing for sexually transmitted infections, especially for people 25 years or younger, is also recommended annually. A Pap smear is recommended every 3 years if you are 21 or older. If you run out of refills on your pill prescription, you should make an appointment with your provider before you run out of birth control pills. Do not wait until the last minute to make your appointment. If you have problems at any time, contact your health care provider.

WHAT SHOULD I DO IF I RUN OUT OF MY PILLS?

First, make sure you have enough pills/prescription refills to last through the holidays, semester breaks, and summer recess before you leave campus. If you miscalculate or lose your pills, contact your pharmacy immediately. If you cannot get more pills, use a backup method of birth control such as condoms. If your backup method fails, consider taking emergency contraception.

SHOULD I TELL OTHER MEDICAL PROVIDERS THAT I AM TAKING THE PILL?

Yes. Birth control pills are a medication. Make sure that all of your health care providers (including pharmacists) know about all of the medications you are taking, including the pill.

DO I NEED TO TAKE A REST FROM THE PILL?

Current data indicate that there is no need to stop the pills at intervals. You should not stop taking the pill without using alternative contraception if you want to avoid pregnancy. Many pill users become pregnant soon after they stop taking the pill.

WHAT DO I DO IF I DECIDE I WANT TO GET PREGNANT?

If you decide you want to get pregnant, call 919-966-2281 to make an appointment for preconception counseling with a provider in Gynecology before you stop taking the pill. This counseling will provide you with important information before conception. For example, you should take 800 mcg of folic acid daily, preferably for at least three months before you stop the birth control pill.

There is no evidence that the pill decreases subsequent fertility, and the return to fertility is usually rapid. Usually pill users return to the pattern of menstruation that was normal for them before they took the pill. Reports have confirmed that inadvertent pill use during early pregnancy does not increase the risk of fetal malformations.

WHAT IF I SWITCH FROM THE PILL TO A DIFFERENT KIND OF HORMONAL CONTRACEPTIVE?

When switching from one kind of pill to a different pill, it is not necessary to use a back-up method of contraception as long as you begin the new pill pack at or before the time you would have started a new pack of your current pill. However, when switching from the pill to other hormonal methods (e.g. NuvaRing®, Ortho Evra® patches, or Depo-Provera® injection), timing is critical. Ask your health care provider if or for how long you might have to use a back-up method of birth control, such as condoms, if you switch from the pill to a different hormonal method. For more details on this question, visit ReproductiveAccess.org.

ARE THERE ANY DRUG INTERACTIONS WITH THE PILL?

Yes, some medications – both prescription and over the counter – as well as some supplements and herbals may decrease the effectiveness of the pill. The pill may also change the effects of other medications. Talk with your healthcare provider to determine if you need to use a backup method or consider a new type of contraception whenever you begin taking prescription or over the counter medications including supplements or herbals. Additionally, the patient package insert for your birth control pill includes specific medication warnings.

WHAT IF I HAVE MORE QUESTIONS?

If you have any questions or concerns regarding the pill or other birth control methods, consult your health care provider or a Sexual Health and Relationship Educator (SHARE) in Student Wellness.

While any health care provider at Campus Health can help you with your birth control questions and needs, Campus Health Services has a Gynecology specialty clinic. If you would prefer a Gynecology practitioner, specify your request when making an appointment at campushealthappointments.unc.edu or 919-966-2281.